Anaplastic Thyroid Cancer: Experience of the Philippine General Hospital.

Lo TE, Jimeno CA, Paz-Pacheco E - Endocrinol Metab (Seoul) (2014)

Bottom Line:
An absence of distant metastases and lymph node involvement was associated with improved survival outcomes, whereas age at diagnosis and tumor size did not affect survival.Curative surgery offers the most effective means of prolonging survival.Radiotherapy and chemotherapy in combination with surgery represents a promising treatment strategy.

Affiliation: Section of Endocrinology and Metabolism, Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippine. tomedwardlo@yahoo.com.

ABSTRACT

Background: Anaplastic thyroid cancer (ATC) is a rare type of thyroid malignancy and one of the most aggressive solid tumors, responsible for between 14% and 50% of the total annual mortality associated with thyroid cancer.

Methods: A retrospective study was made of all ATC cases diagnosed by biopsy in the Philippine General Hospital between 2008 and 2013.

Results: A total of 15 patients were identified, with a median age at diagnosis of 63 years. All tumors were at least 6 cm in size upon diagnosis. All patients had a previous history of thyroid pathology, presenting with an average duration of 11 years. Eleven patients presented with cervical lymphadenopathies, whereas seven exhibited signs of distant metastases, for which the lungs appeared to be the most common site. More than 70% of the patients presented with a rapidly growing neck mass, leading to airway obstruction. Only three patients were treated using curative surgery; the majority received palliative and supportive forms of treatment. In addition, only three patients were offered radiotherapy. Chemotherapy was not offered to any patient. Only two patients were confirmed to still be alive during the study period. The median survival time for the other patients was 3 months; in the majority of cases the patient died within the first year following diagnosis.

Conclusion: Our experience with ATC demonstrated concordance with other institutions with respect to current clinical profile, presentation, and prognosis. An absence of distant metastases and lymph node involvement was associated with improved survival outcomes, whereas age at diagnosis and tumor size did not affect survival. Curative surgery offers the most effective means of prolonging survival. Radiotherapy and chemotherapy in combination with surgery represents a promising treatment strategy.

Figure 2: Comparison of survival times following a diagnosis of anaplastic thyroid cancer.

Mentions:
The median survival time among our Filipino cohort (3 months) was shorter than in other studies, which in the majority of cases stated a survival time for ATC of between 5 and 6 months (Fig. 2) [2627]. Younger age (<45 years), a smaller tumor (<6 to 7 cm), the absence of distant metastasis, and extrathyroidal involvement upon diagnosis were good independent prognostic factors in several international studies [28]. However, Haigh and colleagues [9] reported that neither age nor tumor size was associated with survival. Potentially curative surgery was the only variable associated with prolonged survival in their study following multivariate analysis [9]. In the present study, the absence of distant metastases and lymph node involvement during diagnosis, and immediate curative surgical management via total thyroidectomy, were associated with longer survival times (Table 1).

Figure 2: Comparison of survival times following a diagnosis of anaplastic thyroid cancer.

Mentions:
The median survival time among our Filipino cohort (3 months) was shorter than in other studies, which in the majority of cases stated a survival time for ATC of between 5 and 6 months (Fig. 2) [2627]. Younger age (<45 years), a smaller tumor (<6 to 7 cm), the absence of distant metastasis, and extrathyroidal involvement upon diagnosis were good independent prognostic factors in several international studies [28]. However, Haigh and colleagues [9] reported that neither age nor tumor size was associated with survival. Potentially curative surgery was the only variable associated with prolonged survival in their study following multivariate analysis [9]. In the present study, the absence of distant metastases and lymph node involvement during diagnosis, and immediate curative surgical management via total thyroidectomy, were associated with longer survival times (Table 1).

Bottom Line:
An absence of distant metastases and lymph node involvement was associated with improved survival outcomes, whereas age at diagnosis and tumor size did not affect survival.Curative surgery offers the most effective means of prolonging survival.Radiotherapy and chemotherapy in combination with surgery represents a promising treatment strategy.

Affiliation:
Section of Endocrinology and Metabolism, Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippine. tomedwardlo@yahoo.com.

ABSTRACT

Background: Anaplastic thyroid cancer (ATC) is a rare type of thyroid malignancy and one of the most aggressive solid tumors, responsible for between 14% and 50% of the total annual mortality associated with thyroid cancer.

Methods: A retrospective study was made of all ATC cases diagnosed by biopsy in the Philippine General Hospital between 2008 and 2013.

Results: A total of 15 patients were identified, with a median age at diagnosis of 63 years. All tumors were at least 6 cm in size upon diagnosis. All patients had a previous history of thyroid pathology, presenting with an average duration of 11 years. Eleven patients presented with cervical lymphadenopathies, whereas seven exhibited signs of distant metastases, for which the lungs appeared to be the most common site. More than 70% of the patients presented with a rapidly growing neck mass, leading to airway obstruction. Only three patients were treated using curative surgery; the majority received palliative and supportive forms of treatment. In addition, only three patients were offered radiotherapy. Chemotherapy was not offered to any patient. Only two patients were confirmed to still be alive during the study period. The median survival time for the other patients was 3 months; in the majority of cases the patient died within the first year following diagnosis.

Conclusion: Our experience with ATC demonstrated concordance with other institutions with respect to current clinical profile, presentation, and prognosis. An absence of distant metastases and lymph node involvement was associated with improved survival outcomes, whereas age at diagnosis and tumor size did not affect survival. Curative surgery offers the most effective means of prolonging survival. Radiotherapy and chemotherapy in combination with surgery represents a promising treatment strategy.